白内障手术后眼内炎术前局部应用抗生素预防的成本效益
Cost-Effectiveness of Preoperative Topical Antibiotic Prophylaxis for Endophthalmitis Following Cataract Surgery.
作者信息
Felfeli Tina, Miranda Rafael N, Kaur Jeeventh, Chan Clara C, Naimark David M J
机构信息
From the Department of Ophthalmology and Vision Sciences, University of Toronto (T.F., C.C.C.); Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., R.N.M., D.M.J.N.); Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., D.M.J.N.).
Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., R.N.M., D.M.J.N.); Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., D.M.J.N.).
出版信息
Am J Ophthalmol. 2023 Mar;247:152-160. doi: 10.1016/j.ajo.2022.11.008. Epub 2022 Nov 12.
PURPOSE
To determine the cost-effectiveness of preoperative topical antibiotic prophylaxis for the prevention of endophthalmitis following cataract surgery.
DESIGN
Cost-effectiveness analysis using a decision-analytic microsimulation model.
METHODS
Preoperative topical antibiotic prophylaxis vs no-prophylaxis costs and effects were projected over a life-time horizon for a simulated cohort of 500 000 adult patients (≥18 years old) requiring cataract surgery in theoretical surgical centers in the United States. Efficacy and cost (2021 US dollars) values were obtained from the literature and discounted at 3% per year.
RESULTS
Based on inputted parameters, the mean incidence of endophthalmitis following cataract surgery for preoperative topical antibiotic prophylaxis vs no-prophylaxis was 0.034% (95% CI 0%-0.2%) and 0.042% (95% CI 0%-0.3%), respectively-an absolute risk reduction of 0.008%. The mean life-time costs for cataract surgery with prophylaxis and no-prophylaxis were $2486.67 (95% CI $2193.61-$2802.44) and $2409.03 (95% CI $2129.94-$2706.69), respectively. The quality-adjusted life-years (QALYs) associated with prophylaxis and no-prophylaxis were 10.33495 (95% CI 7.81629-12.38158) and 10.33498 (95% CI 7.81284-12.38316), respectively. Assuming a cost-effectiveness criterion of ≤$50 000 per QALY gained, the threshold analyses indicated that prophylaxis would be cost-effective if the incidence of endophthalmitis after cataract surgery was greater than 5.5% or if the price of the preoperative topical antibiotic prophylaxis was less than $0.75.
CONCLUSIONS
General use of preoperative topical antibiotic prophylaxis is not cost-effective compared with no-prophylaxis for the prevention of endophthalmitis following cataract surgery. Preoperative topical antibiotic prophylaxis, however, would be cost-effective at a higher incidence of endophthalmitis and/or a substantially lower price for prophylaxis.
目的
确定白内障手术前局部应用抗生素预防眼内炎的成本效益。
设计
使用决策分析微观模拟模型进行成本效益分析。
方法
在美国理论上的手术中心，对50万名需要进行白内障手术的成年患者（≥18岁）的模拟队列进行了终身期内术前局部应用抗生素预防与不预防的成本和效果预测。疗效和成本（2021美元）值来自文献，并按每年3%进行贴现。
结果
根据输入参数，白内障手术后术前局部应用抗生素预防与不预防的眼内炎平均发生率分别为0.034%（95%CI 0%-0.2%）和0.042%（95%CI 0%-0.3%），绝对风险降低0.008%。预防组和不预防组白内障手术的平均终身成本分别为2486.67美元（95%CI 2193.61美元-2802.44美元）和2409.03美元（95%CI 2129.94美元-2706.69美元）。与预防组和不预防组相关的质量调整生命年（QALY）分别为10.33495（95%CI 7.81629-12.38158）和10.33498（95%CI 7.81284-12.38316）。假设每获得一个QALY的成本效益标准≤50000美元，阈值分析表明，如果白内障手术后眼内炎的发生率大于5.5%，或者术前局部应用抗生素预防的价格低于0.75美元，那么预防将具有成本效益。
结论
与不进行预防相比，白内障手术前常规使用局部抗生素预防眼内炎不具有成本效益。然而，在眼内炎发生率较高和/或预防价格大幅降低的情况下，术前局部应用抗生素预防将具有成本效益。
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